Provider Demographics
NPI:1538136452
Name:SKOUGE, JOHN WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:WILLIAM
Last Name:SKOUGE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1302 BELLONA AVE
Mailing Address - Street 2:
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-5425
Mailing Address - Country:US
Mailing Address - Phone:410-825-6810
Mailing Address - Fax:410-825-1621
Practice Address - Street 1:1302 BELLONA AVE
Practice Address - Street 2:
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-5425
Practice Address - Country:US
Practice Address - Phone:410-825-6810
Practice Address - Fax:410-825-1621
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0026614174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDK318OtherFEDERAL BC/BS
MDRTZOtherCAREFIRST BLUE CHOICEASC
MD028WOtherCAREFIRST BC/BS MD ASC
MD522376-01OtherCAREFIRST BC/BS MD
MD7665OtherBC/BS MD
MDRTZOtherCAREFIRST BLUE CHOICEASC
MD522376-01OtherCAREFIRST BC/BS MD
MD050ZMedicare ID - Type Unspecified